Sigrid Bjerge Gribsholt1, Reimar Wernich Thomsen2, Elisabeth Svensson2, Bjørn Richelsen3. 1. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: sigrgrib@rm.dk. 2. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 3. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Abstract
BACKGROUND: Few population-based studies provide data on mortality after bariatric surgery. We hypothesized that hypoglycemia could be an underdiagnosed cause of death. OBJECTIVES: To examine perioperative, all-cause, and cause-specific long-term mortality in Roux-en-Y gastric bypass (RYGB) patients versus population comparisons. SETTING: Danish nationwide population-based cohort study. METHODS: We included all 9895 patients who underwent RYGB during 2006-2010, and a 1:25 age- and gender-matched comparison cohort (n = 247,366) (0.3% lost to follow up). We compared mortality rates and computed mortality rate ratios (MRR) for all-cause and cause-specific mortality using Cox regression analysis. For deceased RYGB patients (n = 91), we conducted a detailed medical record audit. RESULTS: The perioperative (30-days) mortality after RYGB was .04% (4/9895). After 4.2 years, RYGB-related mortality (deaths due to intestinal obstruction/intra-abdominal leakage) was .15% (16/9895). All-cause mortality was very similar in the 2 cohorts (median age, 40.2 years; 21.7% men): RYGB cohort, .89% (n = 91); comparison cohort, .92% (n = 2204); MRR = 1.03 (95% confidence interval [CI], .84-1.27). Mortality due to suicide (2.78; 95% CI, 1.44-5.33), accidents (2.29; 95% CI, 1.16-4.54), gastrointestinal diseases (2.01; 95% CI, 1.06-3.84), and infectious diseases (1.75; 95% CI, .98-3.17) was higher in the RYGB cohort versus comparison groups, but mortality from cancer was lower (0.43; 95% CI, .27-.70). Our medical record audit indicated that 8% of deaths after RYGB (n = 7) were possibly hypoglycemia related. CONCLUSION: Perioperative mortality after RYGB is low in Denmark, and subsequent all-cause mortality is similar to that of matched comparisons. After RYGB, patients have substantially increased mortality due to external causes such as suicide, accidents, and possibly hypoglycemia.
BACKGROUND: Few population-based studies provide data on mortality after bariatric surgery. We hypothesized that hypoglycemia could be an underdiagnosed cause of death. OBJECTIVES: To examine perioperative, all-cause, and cause-specific long-term mortality in Roux-en-Y gastric bypass (RYGB) patients versus population comparisons. SETTING: Danish nationwide population-based cohort study. METHODS: We included all 9895 patients who underwent RYGB during 2006-2010, and a 1:25 age- and gender-matched comparison cohort (n = 247,366) (0.3% lost to follow up). We compared mortality rates and computed mortality rate ratios (MRR) for all-cause and cause-specific mortality using Cox regression analysis. For deceased RYGB patients (n = 91), we conducted a detailed medical record audit. RESULTS: The perioperative (30-days) mortality after RYGB was .04% (4/9895). After 4.2 years, RYGB-related mortality (deaths due to intestinal obstruction/intra-abdominal leakage) was .15% (16/9895). All-cause mortality was very similar in the 2 cohorts (median age, 40.2 years; 21.7% men): RYGB cohort, .89% (n = 91); comparison cohort, .92% (n = 2204); MRR = 1.03 (95% confidence interval [CI], .84-1.27). Mortality due to suicide (2.78; 95% CI, 1.44-5.33), accidents (2.29; 95% CI, 1.16-4.54), gastrointestinal diseases (2.01; 95% CI, 1.06-3.84), and infectious diseases (1.75; 95% CI, .98-3.17) was higher in the RYGB cohort versus comparison groups, but mortality from cancer was lower (0.43; 95% CI, .27-.70). Our medical record audit indicated that 8% of deaths after RYGB (n = 7) were possibly hypoglycemia related. CONCLUSION: Perioperative mortality after RYGB is low in Denmark, and subsequent all-cause mortality is similar to that of matched comparisons. After RYGB, patients have substantially increased mortality due to external causes such as suicide, accidents, and possibly hypoglycemia.
Authors: Kathryn H Gordon; Wendy C King; Gretchen E White; Steven H Belle; Anita P Courcoulas; Faith E Ebel; Scott G Engel; Dave R Flum; Marcelo W Hinojosa; Alfons Pomp; Walter J Pories; Dino Spaniolas; Bruce M Wolfe; Susan Z Yanovski; James E Mitchell Journal: Surg Obes Relat Dis Date: 2018-12-06 Impact factor: 4.734
Authors: Valerio Ceriani; Giuliano Sarro; Giancarlo Micheletto; Alessandro Giovanelli; Ahmed S Zakaria; Marco Fanchini; Chiara Osio; Italo Nosari; Alberto Morabito; Antonio E Pontiroli Journal: Int J Obes (Lond) Date: 2018-11-23 Impact factor: 5.095
Authors: Michelle R Lent; Peter N Benotti; Tooraj Mirshahi; Glenn S Gerhard; William E Strodel; Anthony T Petrick; Jon D Gabrielsen; David D Rolston; Christopher D Still; Annemarie G Hirsch; Fahad Zubair; Adam Cook; David J Carey; G Craig Wood Journal: Diabetes Care Date: 2017-07-31 Impact factor: 19.112